Low Back Pain Problems Research Articles

Work-related risk factors and the prevalence of low back pain among low wage workers: results from a cross-sectional study

BackgroundLow back pain, the most commonly reported musculoskeletal problem, is a major burden on individuals, health systems and social care systems with the indirect cost being predominant. It results in disability, poor service, low quality of life and sickness absences in working places. The problem of low back pain and its risk factors among hotel housekeepers are not well known in Ethiopia. Therefore, this study was aimed to investigate the prevalence and identify determinants of low back pain among hotel industries’ housekeepers in Gondar town, Ethiopia.MethodsInstitutional based cross-sectional study was conducted from March to May 2017. A systematic random sampling technique was applied to select 422 study participants, and the data was collected by a standardized Nordic questionnaire for the analysis of musculoskeletal symptoms. Bivariate and multivariable binary logistic regression analyses were performed using SPSS version 20. The significance level was obtained at 95% CI and p-value ≤ 0.05.ResultsThe prevalence of low back pain among hotel housekeepers in Gondar town was 58.1% (95% CI: 53.6, 62.8%). Being temporary employee (AOR: 3.22), type of job which requires reaching/overstretching (AOR: 2.93), engaging in a job that requires repetitive bending (AOR: 1.97), making > 30 beds per day (AOR: 3.19) signified the significant risk factors for low back pain. However, hotel housekeepers who were satisfied in their current job were less impacted by low back pain (AOR: 0.49).ConclusionA high proportion of hotel housekeepers in this study reported they had low back pain. Employment pattern, rest break taken, reaching/overstretching, repetitive bending, job satisfaction, training related to health and safety and numbers of beds making were among the factors associated with low back pain. Hence, ergonomic measures focusing on correcting the arrangement of work station, rest breaks and changing some equipment are potentially important targets to reduce the problem.

Leg Length Discrepancy: The Natural History (And What Do We Really Know).

The long-term effects of small limb length discrepancies have been poorly documented in the literature. References to low back pain, hip pathology, knee pathology, and foot problems abound in the popular literature. Health care providers frequently recommend the use of lifts for structural and functional limb length discrepancies, yet the natural history of limb length inequality as well as the effectiveness of treatments that may be recommended are obscure. The purpose of this paper is to document and evaluate the literature associated with small limb length discrepancies. A search of the English literature was carried out using PubMed to identify papers dealing with the effects of limb length discrepancies. Papers reporting only expert opinion or case reports were excluded. Papers dealing with the natural history of limb length discrepancy as well as studies in which gait analysis was performed in patients with limb length discrepancy were identified. Only 10% of the population has exactly equal lower limb lengths. Approximately 90% of the population has a limb length discrepancy <1.0 cm. Hip and knee pathology is present in an increased number of patients with limb length discrepancies over 5 mm. Hip pathology is more often present in the long leg, knee pathology has been reported in various studies to be more common in either the long or short leg. Low back problems seem to be more common on the short side in patients with limb length discrepancies. A number of different compensatory mechanisms for limb length discrepancy have been identified during gait analysis. There seems to be a consensus that limb length discrepancies >2.0 cm are frequently a problem. There is some evidence that limb length discrepancies as little as 5 mm can lead to long-term pathology.

Can Biomechanics Research Lead to More Effective Treatment of Low Back Pain? A Point-Counterpoint Debate.

Although biomechanics plays a role in the development and perhaps the persistent or recurrent nature of low back pain (LBP), whether biomechanics alone can provide the basis for intervention is debated. Biomechanics, which refers to the mechanics of the body, including its neuromuscular control, has been studied extensively in LBP. But, can gains be made in understanding LBP by research focused on this component of biology in the multifactorial biopsychosocial problem of LBP? This commentary considers whether biomechanics research has the potential to advance treatment of LBP, and how likely it is that this research will lead to better treatment strategies. A point-counterpoint format is taken to present both sides of the argument. First, the challenges faced by an approach that considers biomechanics in isolation are presented. Next, we describe 3 models that place substantial emphasis on biomechanical factors. Finally, reactions to each point are presented as a foundation for further research and clinical practice to progress understanding of the place for biomechanics in guiding treatment of LBP. J Orthop Sports Phys Ther 2019;49(6):425-436. Epub 15 May 2019. doi:10.2519/jospt.2019.8825.

NYERI PUNGGUNG BAWAH PADA IBU HAMIL TRIMESTER II DAN III

Low Back Pain is a complaint of complex pain that occurs most frequently in the world and Indonesia. Lower back pain in pregnant women of the second and thrid trimester is a common complaint that often occurs among pregnant women, it is estimated that about 70% of pregnant women complain of some form of back pain at some time in pregnancy, labor until postpartum. This study was conducted to describe lower back pain in pregnant women in the third trimester. A cross-sectional descriptive study design, consecutive sampling was conducted in June 2018, using a questionnaire. Research subjects were pregnant women in the second and third trimester. There are 30 respondents entered the study, respondents who experienced mild pain as much as 20%, 50% experienced moderate pain and as much as 30% experienced severe pain accompanied by accompanying symptoms. Although it is a problem, 82% of teenagers just leave it when pain arises or just drink warm water and suppress the affected part (18%). In the second and t hird trimester pregnant women seek help from their husbands and families (87.2%) regarding problems that arise and only 12.8% of the second and third trimester pregnant women seek help from health workers /midwives . Most respondents have experienced lower back muscle pain. Generally, the information about the lower back is mostly obtained from other pregnant women and parents. When experiencing a lower back most pregnant women ask for help to their husbands and families. Health education about the problem of low back pain is important for the second and third-trimester pregnant mother, husband and family, and the need for routine evaluation of low back pain problems in the second and third-trimester pregnant mothers by clinicians. Keywords: low back pain, second and third- trimester pregnant women

Effective Recovery and Control of Chronic Low Back Pain by using Rehabilitation Exercises Therapy

Exercise is a commonly recommended treatment for chronic low back pain due to its effectiveness in enhancing work and function. This study aims to review numerous crucial phases of the usefulness and safety of exercise in order to provide vital information for treating chronic low back pain. An online literature search of Medline was performed using “exercise,” “fitness,” “low back pain,” “backache” and “rehabilitation” as search words abstracts that identified using this method were carefully read, and relevant articles were considered for further analysis. Additional materials were gathered by sourcing relevant research articles. The articles were carefully examined for relevance. There is no evidence that exercise increases low back pain problems, particularly for people with acute, subacute or chronic low back pain. Current studies indicate that exercise has either a neutral effect or might reduce the risk of future back injuries to some extent. Exercise might be suggested for patients with chronic low back pain for three purposes. The first and most recognized purpose is to enhance or decrease deficiencies in back flexibility and strength and improve the performance of endurance activities. It is evident that this purpose can be achieved for most patients suffering from chronic low back pain. The second purpose of exercise is to decrease the severity of low back pain. Many studies reported an overall decrease in the intensity of low back pain ranging from 10% to 50% subsequent to exercise treatment. The third purpose of the exercise is to decrease low back pain–related incapacity by desensitizing worries and anxieties and changing pain attitudes and beliefs. The exercise mechanisms that can be employed to achieve the aforementioned purposes have been the subject of extensive study. The relevance of using exercise as a therapeutic method to decrease deficiencies in back flexibility and strength has been established. Several studies reported enhancements in global pain ratings subsequent to exercise programs. Exercise can also reduce the cognitive, behavioral, and disability effects of low back pain conditions.

Low back pain and associated disability in Swedish adolescents.

IntroductionLow back pain (LBP) defined as ache or pain in the lowest part of the back is a common experience among people all over the world. The lifetime prevalence is reported to be as high as 84%, and the prevalence of LBP seems to be almost the same among adolescents as among adults. The risk for having LBP later in life if you experienced LBP in adolescence is high.Material and MethodsIn this cross‐sectional study of 2550 students aged 16‐20 years, we used the Standardized Nordic Questionnaire for the analysis of musculo‐skeletal symptoms. We studied gender difference, prevalence, and disability of Low back pain. We also studied differences in LBP in adolescent athletes depending on hours spent on sports or physical activity.ResultsSignificantly, more girls than boys had had problems sometimes during their life. Those who participated in sports reported LBP to a significantly higher extent than those who were physically inactive in their spare time. Gender and spare time sports were important risk factors for getting LBP some time in life. There was a higher risk for girls to have low back pain problems more than 30 days or daily the last year if they had had low back pain some time earlier in life.ConclusionThis study shows that low back pain (LBP) is common among Swedish adolescents, more common among girls than boys. High sport activity was associated with the risk of having LBP, length of time with LBP, and disability due to LBP.

Sports participation and low back pain in schoolchildren.

Low back pain (LBP) is one of the biggest health problems worldwide. The purpose of this study was to investigate the association between sports participation (duration and type) and LBP related outcomes in childhood. This cross-sectional study involved 5th and 6th grade primary school students. The final sample included 2,032 children aged 10-12 years old. Children completed a questionnaire about the prevalence of LBP and some LBP-related outcomes. In addition, the participants were surveyed about the type of sport they did and the duration. There appears to be no relation between sports participation and severity of LBP-related outcomes studied, independently of their duration. Participating in football ⩾ 4 hours per week was associated with a decrease of six LBP-related outcomes (OR ranging from 0.54 to 0.66). Basketball participation does not seem to affect the development of back problems amongst children. It can be suggested with caution that doing sport is not dangerous for LBP problems in children aged 10-12 years old. Nevertheless, this suggestion should be tested with further longitudinal and intervention studies to confirm the results.

Assessment of risk factors for non-specific chronic disabling low back pain in Japanese workers-findings from the CUPID (Cultural and Psychosocial Influences on Disability) study.

The majority of patients with non-specific low back pain (LBP) suffer from chronic pain. Psychosocial factors play an important role in the chronicity of LBP. To explore the risk factors for chronic disabling LBP in detail, we assessed its various risk factors in Japanese workers, using data from the Cultural and Psychosocial Influences on Disability (CUPID) study. Data were drawn from a 1 yr follow-up of 20‒59 yr-old workers who participated in the CUPID study. A self-administered questionnaire assessed various factors, including individual characteristics, ergonomic work demands, and work-related or other psychosocial factors. Logistic regression analyses were performed to assess the associations between these factors and chronic disabling LBP. Of 198 participants, 35 (17.7%) had chronic disabling LBP during the 1 yr follow-up. Multivariate logistic regression analysis revealed that the interaction effect of the two factors, expectation of LBP problems and excessive working hours (≥ 60 h per week), was associated with chronic disabling LBP. Chronic disabling LBP was present in 42.5% of participants with both of these two risk factors, whereas it was present in 11.8% of participants without these risk factors. In conclusion, among various factors, the combination of two psychosocial factors was particularly associated with chronic disabling LBP.

Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions

ObjectiveTo identify potentially effective complementary approaches for musculoskeletal (MSK)–mental health (MH) comorbidity, by synthesising evidence on effectiveness, cost-effectiveness and safety from systematic reviews (SRs).DesignScoping review of SRs.MethodsWe searched literature databases,...

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P27. The phenomenon of temporary increase of herniated disc on dynamic MRI control

BACKGROUND CONTEXT MRI is an objective and basic method of diagnosing a herniated disc. In terms of hernia size, most specialists decide on the tactics of further treatment (try conservative therapy or surgery). And certainly all specialists seeing in the dynamics of an increase in hernia size interpret this as an indication for the surgical intervention. In our study, we show that an increase in the size of a hernia and a simultaneous change in its signal characteristics may precede its further decrease. PURPOSE To break the paradigm that increase of herniated disc on MRI is always an indication for surgical intervention. STUDY DESIGN/SETTING Prospective observational study. OUTCOME MEASURES Dynamics of changes in the size of herniated disc and its signal chatacteristics in MRI images. METHODS The study included 135 patients with an intervertebral extrusion present in the L4-5, L5-S1 segments aged 35–55years, 73 of them men and 62 women. In all patients, the intervertebral hernia was diagnosed within 3 months preceding the start of the study. The average extrusion size was 8.8 mm. All patients received gabapentin as an analgetic. An MRI was performed 3times with a 30-day interval. Assessment of the dynamic of patient improvement was performed using short programs: MRI: – T2 sagittal – TR=4,490 ms, TE=121 ms, dist. factor (slice gap) 0%, FOV=300 mm, slice thickness=3 mm; - T2 transversal - TR=7,530 ms, TE=124 ms, dist. factor (slice gap) 0%, FOV=180 mm, slice thickness=3 mm. RESULTS Patients were divided into two groups based on the character of the dynamic changes seen in the signal characteristics of disc hernias: (1) increase in signal (diffuse or focal) from the disc, with significant increase in the size of the hernia (2–5 mm), which can be caused by inflammatory edema and neovascularization. The increase in size could be regarded as a negative dynamic, but further observation within 90days after the first MRI showed a decrease in the size of the hernia (3-7 mm) and an improvement of the clinical symptoms in 89 patients; and (2) in 46 patients, the disc signal did not change, neither did the size of the hernia, which resulted in surgical intervention being indicated for herniated disc removal. CONCLUSIONS The active change in the structure and especially the size of the hernia in a relatively short time interval (1–2 months) should not serve as an absolute indication for surgical intervention, as our study has shown, in the majority of patients the hernia regresses over the next few months. This phenomenon requires further immunobiological studies. It is also necessary to systematize the enormous information obtained in MRI diagnostics (not only in size, but also in structure) into a single classification unified for all specialists dealing with the problem of low back pain, which will reduce the number of unreasonable surgical interventions.

Friday, September 28, 2018 8:00 AM–9:00 AM interdisciplinary spine forum: abstract presentations: 142. Integrating multidisciplinary knowledge of low back pain through collaborative modeling: results from the NASS think tank workshop

BACKGROUND CONTEXT Low back pain (LBP) is a very complex problem with numerous bio-psycho-social factors interacting to impact pain, disability, and quality of life. To understand the dynamics of such a complex problem, it needs to be studied in its entirety (systems approach). Although this concept is accepted by the scientific and clinical communities, much research to date is conducted by specialized teams focusing on isolated factors related to LBP. Such a reductionist approach may be useful in some circumstances, but it also creates barriers for integrating knowledge between disciplines and ultimately precludes the understanding of the dynamics of the entire LBP problem. To leverage the knowledge shared among various stakeholders, an innovative process called collaborative modeling was developed within the field of systems science specifically for enhancing the understanding of complex, multifactorial systems dynamics. This study assessed the feasibility of using this approach for integrating multidisciplinary knowledge of LBP. METHODS Participants (n=29), who have contributed significant knowledge to the area of LBP (eg publications, contributions to societies, etc.), were selectively recruited for this study and represented diverse disciplines: Basic Science (n=7), Chiropractic (n=4), Spine Surgery (n=2), Physical Medicine & Rehabilitation (n=2), Physical or Exercise Therapy (n=12), and Psychology (n=2). Each participant underwent a structured one-on-one interview to construct a fuzzy-logic cognitive map (FCM) (Mental Modeler software, www.mentalmodeler.org ) representing his or her understanding of how factors related to LBP interact and affect patient outcomes (pain, disability and quality of life). All individual FCMs were then converted to adjacency matrices and integrated into one meta-model (Gephi software, www.gephi.org ). To demonstrate the integrated meta-model's potential, various intervention strategies listed in all FCMs were simulated and their relative effects on pain, disability, and quality of life were investigated. RESULTS The meta-model, that integrated the understanding of LBP of all participants, consisted of 272 factors and 1,429 connections representing interactions among these factors. Simulations of individual treatment interventions predicted that combined aerobic exercise, counseling, and education are likely to be the most effective intervention to reduce pain. Meditation, followed by cognitive behavioral therapy, had the greatest impact on reducing disability and improving quality of life. CONCLUSIONS The integration of 29 FCMs, representing diverse participants’ views of LBP dynamics, resulted in a model that was extremely complex, but still feasible to produce meaningful interpretations. The simulations provided outcomes that broadly agreed with data in the literature, which suggests that aerobic exercise, counseling, education, meditation, and cognitive behavioral therapy are effective LBP interventions. Although the selection of participants and the relatively small sample size may influence the results, the findings suggest that it is possible to integrate multidisciplinary knowledge of LBP into one meta-model. This approach could provide the framework for a larger, community-wide platform for further development and refinement of this meta-model. Such a meta-model could then be used to simulate other “what if” scenarios, to identify gaps in knowledge, and to inform new essential research directions to ultimately improve patient care and outcomes for LBP.

Effect of General Versus Specialized Exercises on Movement Control of Lumbo- Pelvic Region in Subjects with Chronic Low Back Pain

Research background and hypothesis. Low back pain is a huge problem in the world. One of the main reasons why the low back pain problems arise is lumbo-pelvic motor control dysfunction. Specialized exercises are the basis of physical therapy for low back pain patients. Hypothesis: specialized exercises can be more effective for movement control of lumbo-pelvic region in subjects with chronic low back pain.Research aim was to assess the effect of general versus specialized exercises for movement control of lumbo-pelvic region in subjects with chronic low back pain.Research methods. The study involved 60 subjects with chronic low back pain, 29 women and 31 men, aged 21.5 years on average. All subjects were submitted to the Low Back Pain Duration and Beacke Habitual Physical Activity Assessment questionnaires (Baecke et al., 1982). Lumbo-pelvic motion control was evaluated by six Hannu Luomajoki movement control tests (Luomajoki et al., 2008). Specialized and general training programs were prescribed and performed under supervision of physical therapist. Video materials expert analysis was used for the evaluation of the study data.Research results. The results showed that a specialized training program was more effective than general exercises in improving movement control in lumbo-pelvic region for patients with low back pain.Discussion and conclusions. General exercise training program for general exercise group had no effect for all test results. Specialized exercise training program results showed that lumbo-pelvic movement control improved in five of the six control tests (p &lt; 0.05).Keywords: motor control, physical therapy program, stability, mobility.

Time‐dependent lumbar spinal cord astrocytic hyperactivation occurs in the deep dorsal horn during the maintenance of nerve growth factor‐induced low back pain

Low back pain (LBP) is a complex condition that is a substantial global socioeconomic problem. LBP is poorly managed, in part, due to a lack of efficacious treatments. Determining the underlying mechanisms contributing to LBP will help to discover new therapies to impact this global crisis. In this study, we used a preclinical model of LBP induced by nerve growth factor (NGF) injections into the lumbar paraspinal muscles. It was previously shown that NGF injections induce persistent low back mechanical hyperalgesia (hypersensitivity to a noxious mechanical stimulus) and nociceptive neuronal hyperexcitability in the lumbar spinal cord deep dorsal horn (DDH), which contributes to central sensitization. Central sensitization is key to the development of persistent pain. Neuroimmune activation (astrocytic &amp; microglial hyperactivation &amp; enhanced proinflammatory cytokines) also plays a critical role in central sensitization. We previously reported that astrocytic hyperactivation occurred in the ipsilateral lumbar spinal cord superficial dorsal horn, where pain is processed and modulated, during the maintenance of NGF‐induced persistent LBP. Recent reports examining the induction of persistent LBP suggest that glial hyperactivation also occurs in the DDH, where pain projection neurons are located. The objective of this study was to investigate astrocytic hyperactivation in the DDH during the maintenance of persistent LBP. We hypothesized that NGF injections would induce astrocytic hyperactivation in the lumbar spinal cord DDH during the maintenance of LBP. We tested our hypothesis using the NGF LBP model and immunofluorescence with confocal microscopy. We administered two injections (50μl) 5 days apart on Day 0 (D0) and Day 5 (D5) of NGF (0.8μM) or vehicle (PBS) into the left paraspinal muscles (5th lumbar vertebral level) in male rats. Low back mechanical hyperalgesia (LBP) was assessed before injections on D0 and D5, and at other time points (D2, D5+4 hours, D7, D10, &amp; D14). Lumbar spinal cords (L1–L6; formalin fixed &amp; transversely sectioned at 30μm) were evaluated for immunofluorescence labeling of the astrocyte marker, glial fibrillary acidic protein (GFAP), in the DDH bilaterally (Image J; inter‐ and intra‐rater reliability ICC= 0.77 &amp; 0.83). NGF‐injected rats displayed significant reductions in ipsilateral low back noxious mechanical thresholds post‐injection on D5 through D14 compared to controls. At D14, NGF rats (n=4) demonstrated a significant increase in mean fluorescence intensity for GFAP, in the DDH ipsilateral to injections with characteristic appearances of hyperactivated astrocytes (i.e., hypertrophic cell bodies &amp; processes) compared to vehicle (n=4). No significant changes were observed at D5 (4 hours post‐NGF injection) or D7. These findings suggest that time‐dependent astrocytic hyperactivation occurs in the DDH during the maintenance of LBP, further supporting the role that spinal cord neuroimmune activation plays in persistent LBP. This study provides a foundation that may help identify novel therapies to improve treatment efficacy and impact the problem of LBP.Support or Funding InformationSLU Center for Neuroscience SCFN‐SGP‐01This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Low back pain: a call for action

Low back pain is the leading worldwide cause of years lost to disability and its burden is growing alongside the increasing and ageing population.1 Because these population shifts are more rapid in low-income and middle-income countries, where adequate resources to address the problem might not exist, the effects will probably be more extreme in these regions. Most low back pain is unrelated to specific identifiable spinal abnormalities, and our Viewpoint, the third paper in this Lancet Series,2,3 is a call for action on this global problem of low back pain.

Low back pain: a major global challenge

Low back pain is a major problem throughout the world and it is getting worse—largely because of the ageing and increasing world population. 1 GBD 2016 Disease and Injury Incidence and Prevalence CollaboratorsGlobal, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390: 1211-1259 Summary Full Text Full Text PDF PubMed Scopus (4135) Google Scholar It affects all age groups and is generally associated with sedentary occupations, smoking, obesity, and low socioeconomic status. 2 Hartvigsen J Hancock MJ Kongsted A et al. What low back pain is and why we need to pay attention. Lancet. 2018; (published online March 21.)http://dx.doi.org/10.1016/S0140-6736(18)30480-X Summary Full Text Full Text PDF PubMed Scopus (1564) Google Scholar Years lived with disability caused by low back pain have increased by more than 50% since 1990, especially in low-income and middle-income countries (LMICs). 1 GBD 2016 Disease and Injury Incidence and Prevalence CollaboratorsGlobal, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390: 1211-1259 Summary Full Text Full Text PDF PubMed Scopus (4135) Google Scholar , 2 Hartvigsen J Hancock MJ Kongsted A et al. What low back pain is and why we need to pay attention. Lancet. 2018; (published online March 21.)http://dx.doi.org/10.1016/S0140-6736(18)30480-X Summary Full Text Full Text PDF PubMed Scopus (1564) Google Scholar Disability related to low back pain is projected to increase most in LMICs where resources are limited, access to quality health care is generally poor, and lifestyle changes and shifts towards more sedentary work for some mean the risks will only increase. What low back pain is and why we need to pay attentionLow back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide. For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Full-Text PDF Prevention and treatment of low back pain: evidence, challenges, and promising directionsMany clinical practice guidelines recommend similar approaches for the assessment and management of low back pain. Recommendations include use of a biopsychosocial framework to guide management with initial non-pharmacological treatment, including education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms. Guidelines recommend prudent use of medication, imaging, and surgery. The recommendations are based on trials almost exclusively from high-income countries, focused mainly on treatments rather than on prevention, with limited data for cost-effectiveness. Full-Text PDF Low back pain: a call for actionLow back pain is the leading worldwide cause of years lost to disability and its burden is growing alongside the increasing and ageing population.1 Because these population shifts are more rapid in low-income and middle-income countries, where adequate resources to address the problem might not exist, the effects will probably be more extreme in these regions. Most low back pain is unrelated to specific identifiable spinal abnormalities, and our Viewpoint, the third paper in this Lancet Series,2,3 is a call for action on this global problem of low back pain. Full-Text PDF

The efficacy of a multimodal physical activity intervention with supervised exercises, health coaching and an activity monitor on physical activity levels of patients with chronic, nonspecific low back pain (Physical Activity for Back Pain (PAyBACK) trial): study protocol for a randomised controlled trial

BackgroundPhysical activity plays an important role in the management of chronic low back pain (LBP). Engaging in an active lifestyle is associated with a better prognosis. Nevertheless, there is evidence to suggest that patients with chronic LBP are less likely to meet recommended physical activity levels. Furthermore, while exercise therapy has been endorsed by recent clinical practice guidelines, evidence from systematic reviews suggests that its effect on pain and disability are at best moderate and not sustained over time. A limitation of current exercises programmes for chronic LBP is that these programmes are not designed to change patients’ behaviour toward an active lifestyle. Therefore, we will investigate the short- and long-term efficacy of a multimodal intervention, consisting of supervised exercises, health coaching and use of an activity monitor (i.e. Fitbit Flex) compared to supervised exercises plus sham coaching and a sham activity monitor on physical activity levels, pain intensity and disability, in patients with chronic, nonspecific LBP.MethodsThis study will be a two-group, single-blind, randomised controlled trial. One hundred and sixty adults with chronic, nonspecific LBP will be recruited. Participants allocated to both groups will receive a group exercise programme. In addition, the intervention group will receive health coaching sessions (i.e. assisting the participants to achieve their physical activity goals) and an activity monitor (i.e. Fitbit Flex). The participants allocated to the control group will receive sham health coaching (i.e. encouraged to talk about their LBP or other problems, but without any therapeutic advice from the physiotherapist) and a sham activity monitor. Outcome measures will be assessed at baseline and at 3, 6 and 12 months post randomisation. The primary outcomes will be physical activity, measured objectively with an accelerometer, as well as pain intensity and disability at 3 months post randomisation. Secondary outcomes will be physical activity, pain intensity and disability at 6 and 12 months post randomisation as well as other self-report measures of physical activity and sedentary behaviour, depression, quality of life, pain self-efficacy and weight-related outcomes at 3, 6, and 12 months post randomisation.DiscussionThis study is significant as it will be the first study to investigate whether a multimodal intervention designed to increase physical activity levels reduces pain and disability, and increases physical activity levels compared to a control intervention in patients with chronic LBP.Trial registrationClinicalTrials.gov, ID: NCT03200509. Registered on 28 June 2017.

Factors Associated with Low Back Pain Among Nurses in Critical Care Units, Hospital Universiti Sains Malaysia

Nursing is a high risk group profession with prevalence of low back pain LBP. Nursing literature shows that efforts have been done to try and reduce the problem of work-related low back pain while moving and handling, by training and the provision of handling aids...

The Relationship between Prolonged Sitting Position and Adaptive Alterations in Lumbar Spine and Pelvic Range of Motion in Cyclists with Chronic Low Back Pain

Background: The majority of low back pain (LBP) problems in athletes are the result of stress induced by prolonged postures or repeated movements. Cycling is a sport that needs prolonged trunk flexion during the activity.& para;& para;Objective: To compare sagittal lumbar spine and sagittal pelvic tilt range of motion (ROM) between athletes with CLBP (chronic low back pain) who regularly ride bicycles and healthy controls without regular bicycle riding.& para;& para;Methods: Nineteen cyclists with CLBP and 20 asymptomatic non-cyclist athletes participated in the study, (mean age: 26.00 +/- 8.67 years). Sagittal lumbar spine and sagittal pelvic tilt range of motion (ROM) were measured during forward bending and backward return clinical tests using a three-dimensional motion capture system.& para;& para;Results: During forward bending. cyclists with CLBP demonstrated a limited anterior pelvic tilt angle (p = 0.03), compared to non-cyclists athletes. No significant differences were found in lumbar flexion angle between the groups during the test. During Backward return, cyclists with CLBP exhibited a limited posterior pelvic tilt angle (p = 0.02) and lumbar-extension range = 0.05). compared to non-cyclist athletes.& para;& para;Conclusions: A regular sitting position on the bicycle for a prolonged period may result in adaptations in sagittal lumbar and pelvic ROM which may contribute to the development of LBP.

EVALUASI POSTUR KERJA DAN KELUHAN MUSKOLOSKELETAL PADA PEKERJA INSTALASI FARMASI

Pharmaceuthical department is one of many department in RSUD Kota Madiun which serve hundreds of patients everyday. Workers on pharmacuthical department has been found having unnatural working posture on their work process, where many workers tend to complain about having low back pain problems. One of suspected problem is unnatural working posture. Unergonomic position, repetitive works, sit for long periods were few of ergonomics problem which occurred everyday. This research aimed to identify work posture and musculoskeletal complaint on pharmaceuthical department workers. This research used cross sectional approach, with population sample were all worker on pharmaceuthical department RSUD Kota Madiun and there are eight people in total. Primary data on this research collected using questionnaires, Body Mass Index measurements, interviews, and observations. Collected data from questionnaires, interview, and Body Mass Index measurements were processed, and the processed data will be analyzed using qualitatif methods of deep interview. The result showed most of worker were having high riks of having musculoskeletal problem based on RULA and REBA evaluation. Most of musculoskeletal complaints were located on their waist, hip, upper neck an lower neck. Hospital should give the workers egonomical training so that workers could avoid having unergonomical posture which lead to musculoskeletal problems. Workers should doing more often aerobic exercise.Keywords: muscoloskeletal complaint, work posture

Profile of clinical information in medical records of tobacco farmers in Alagoas, Brazil.

The study of the profile of medical records of tobacco growers contributes to discussions on the establishment of diagnosis and its causal correlation with work. To investigate the profile of clinical information in medical records of tobacco growers. The present was a descriptive field and documentary study, with quantitative approach, of 149medical records of farmers who visited basic health units in rural communities in the municipality of Arapiraca, Alagoas, Brazil, from 2008 to 2013. About 66% of the investigated population was female, with average age 58.6 years old (standard deviation ±16.4). The most significant clinical complaint found in the records was headache (16.71%), followed by low back pain (10.20%), dysuria or other urinary problems (8.90%) and stomachache (8.30%). Medical diagnoses included gastritis (15.1%), depression (7.1%), anxiety (7.1%), myalgia (7.1%) and arthritis/arthralgia (5.3%). Correlation between clinical complaints and work performed by tobacco growers was registered on one single medical record. The clinical profile of tobacco growers described in the medical records might be associated with their social and working conditions and related to pesticide and nicotine poisoning. However, the scarcity of information on the environmental and occupational risk context limits the establishment of a causal link. As a function of the relevance of the occupational-clinical conditions of this population of workers, improving medical records is necessary, as the temporal relationship between exposure and outcomes might account for the occurrence of the reported symptoms.